HIV/AIDS in Africa

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HIV/AIDS is a major public health problem and the cause of death in many parts of Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total infected worldwide - about 35 million people - are Africans, of whom 15 million have died. Sub-Saharan Africa alone accounts for about 69 percent of all people living with HIV and 70 percent of all AIDS deaths in 2011. In the most affected African sub-Saharan countries, AIDS has increased mortality rates and lowered life expectancy at between adults between the ages of 20 and 49 for about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic with life expectancy in some countries reaching as low as thirty-four years.

Countries in North Africa and the Horn of Africa have significantly lower prevalence rates, as their populations are usually involved in fewer high-risk cultural patterns that have been implicated in the spread of the virus in Sub-Saharan Africa. South Africa is the most severely affected region on the continent. In 2011, HIV has infected at least 10 percent of the population in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.

In response, a number of initiatives have been launched in various parts of the continent to educate the public about HIV/AIDS. Among these are the combined prevention programs, considered the most effective initiatives, such as taboo, loyalty, using condom campaigns and the Outreach Program of the Foundation's Desmond Tutu HIV Foundation.

According to a special report 2013 issued by the UN Joint Program on HIV/AIDS (UNAIDS), the number of HIV-positive people in Africa who received anti-retroviral treatment in 2012 was more than seven times the number receiving treatment in 2005, " 1 million added in the last year alone ". The number of AIDS-related deaths in Sub-Saharan Africa in 2011 was 33 percent lower than the number in 2005. The number of new HIV infections in Sub-Saharan Africa in 2011 was 25 percent lower than the number in 2001.

Video HIV/AIDS in Africa

Overview

In an article entitled "The Impact of HIV & AIDS in Africa", the charity AVERT wrote:

HIV... has caused tremendous human suffering on this continent. The most obvious effect... is disease and death, but the impact... is not... limited to the health sector; households, schools, workplaces and the economy are also affected....

In sub-Saharan Africa, people with HIV-related disease account for more than half of all hospital beds.... [L] the number of health care professionals is being directly affected.... Botswana, for example, lost 17% of its health care workforce due to AIDS between 1999 and 2005....

The number of HIV and AIDS victims in the household can be very severe.... [I] t is often the poorest sector of the most vulnerable society.... In many cases, AIDS causes households to dissolve, as parents die and children are sent to relatives for care and upbringing.... Much has happened before this dissolution takes place: AIDS strips families of their assets and income, increasingly impoverishing the poor....

The... the epidemic adds to food insecurity in many areas, because agricultural work is neglected or abandoned due to domestic disease....

Almost always, the burden of coping lies in women. When a family member gets sick, the role of women as caregivers, breadwinners, and housemaids increases. They are often forced to step into roles outside their homes as well....

Older people are also deeply affected by the epidemic; many have to care for their sick and often abandoned children to care for orphaned grandchildren....

It's hard to overestimate the trauma and hardships that the kids... are forced to endure.... When parents and family members become sick, children take more responsibility to earn income, produce food, and take care of family members.... [M] ore children have become orphaned due to AIDS in Africa than elsewhere. Many children are now raised by their extended family and some are even left alone in child-headed households....

HIV and AIDS have a very bad impact on the supply of inadequate teachers in African countries.... The disease or death of teachers is devastating in rural areas where schools rely heavily on one or two teachers.... [I] n Tanzania [,] for example [...] in 2006 it is estimated that around 45,000 additional teachers are needed to redeem those who have died or leave jobs due to HIV.... br>
AIDS destroys business by reducing productivity, increasing costs, diverting productive resources, and depleting skills.... Also, as the impact of the epidemic on households grows more severe, market demand for products and services can go down....

In many countries in sub-Saharan Africa, AIDS erases decades of progress in prolonging life expectancy.... The greatest increase in death... has occurred among adults aged between 20 and 49 years. This group now accounts for 60% of all deaths in sub-Saharan Africa.... AIDS attacks adults in the most economically productive years and removes people who can respond to crises....

Because access to treatment is slowly extended across the continent, millions of lives are prolonged and hope is given to people who previously did not have it. Unfortunately though, the majority of people in need of care still have not received it, and campaigns to prevent new infections... are lacking in many areas.

Maps HIV/AIDS in Africa

The current hypothesis also includes that, once the virus jumps from chimpanzees or other apes to humans, twentieth-century colonial medical practice helped HIV become established in the human population in 1930. The virus probably moved from primates to humans when the hunter came into contact with blood infected primates. The hunters then become infected with HIV and transmit the disease to other humans through contamination of body fluids. This theory is known as "Bushmeat theory".

HIV makes the leap from rural isolation to rapid urban transmission as a result of the urbanization that occurred during the 20th century. There are many reasons for the prevalence of AIDS in Africa. One of the most formative explanations is the poverty that dramatically impacts the daily lives of Africans. Books, Ethics and AIDS in Africa: A Challenge to Our Thoughts, illustrates how "Poverty has its accompanying side effects, such as prostitution (ie the need to sell sex for survival), poor living conditions, education, health and health care, the main factors contributing to the current spread of HIV/AIDS. "

Researchers believe HIV is gradually spread by river travel. All rivers in Cameroon flow into the Sangha River, which joins the Congo River through Kinshasa in the Democratic Republic of Congo. Trade along the river can spread the virus, which is slowly awakening in the human population. In the 1960s, about 2,000 people in Africa may have HIV, including those in Kinshasa whose tissue samples from 1959 and 1960 have been preserved and studied retrospectively. The first HIV/AIDS epidemic is believed to have occurred in Kinshasa in the 1970s, characterized by a surge of opportunistic infections such as cryptococcal meningitis, Kaposi's sarcoma, tuberculosis, and pneumonia.

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History

Acquired immunodeficiency syndrome (AIDS) is a deadly disease caused by the slow human immunodeficiency virus (HIV). Viruses multiply in the body to cause damage to the immune system, leading to AIDS syndrome. HIV emerged in Africa in 1960 and traveled to the United States and Europe in the next decade. In the 1980s it spread silently around the world until it became a pandemic, or widespread. Some areas of the world have been significantly affected by AIDS, while in some other countries the epidemic has just begun. Viruses are transmitted through body fluid contact including exchange of sexual fluids, by blood, from mother to child in the womb, and during labor or breastfeeding. AIDS was first identified in the United States and France in 1981, especially among homosexual men. Then in 1982 and 1983, heterosexual Africans were also diagnosed.

In the late 1980s, international development agencies regarded AIDS control as a technical medical issue rather than involving all areas of economic and social life. Because public health authorities consider AIDS to be an urban phenomenon associated with prostitution, they believe that the majority of Africans living in "traditional" rural areas will be spared. They believe that heterosexual epidemics can be contained by focusing prevention efforts on persuading so-called core transmitters - people like sex workers and truck drivers, known to have multiple sex partners - to use condoms. These factors inhibit prevention campaigns in many countries for more than a decade.

Although many governments in Sub-Saharan Africa have denied that there have been problems for years, they are now beginning to work towards a solution.

AIDS was initially thought of as a disease of gay men and drug addicts, but in Africa it took off among the general population. As a result, those involved in the fight against HIV began to emphasize aspects such as preventing mother-to-child transmission, or the relationship between HIV and poverty, gender inequalities, and so on, rather than emphasizing the need to prevent transmission by unsafe sexual practices or drug injections. This change of emphasis generates more funds, but is not effective in preventing the dramatic increase in HIV prevalence.

The global response to HIV and AIDS has increased greatly in recent years. Funding comes from many sources, the largest of which is the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Aid.

According to the UN Joint Program on HIV/AIDS (UNAIDS), the number of HIV-positive people in Africa who received anti-retroviral treatment increased from 1 million to 7.1 million between 2005 and 2012, up 805%. Nearly 1 million of these patients were treated in 2012. The number of HIV-positive people in South Africa who received such treatment in 2011 was 75.2 percent higher than the number in 2009.

In addition, the number of AIDS-related deaths in 2011 in Africa as a whole and Sub-Saharan Africa alone was 32 percent less than the number in 2005. The number of new HIV infections in Africa in 2011 was also 33 percent lower than the number in 2001, with a "24% reduction in new infections among children from 2009 to 2011". In Sub-Saharan Africa, new HIV-positive cases in the same period decreased by 25%. According to UNAIDS, this success resulted from "strong leadership and shared responsibility in Africa and among the global community".

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Prevention of HIV infection

Public education initiative

A number of public education initiatives have been launched to curb the spread of HIV in Africa.

Role of stigma

HIV and AIDS have attracted tremendous stigmatization. This is due to many factors such as a lack of understanding of the disease, lack of access to treatment, the media, knowing that AIDS is incurable, and the prejudices brought about by cultural beliefs. "When HIV/AIDS becomes a global disease, African leaders play ostriches and say that it is a gay disease found only in the West and Africa not to worry as there are no gays and lesbians in Africa." Africans are blind to the already enormous epidemic that permeates their community. The belief that only homosexuals could get sick is denied because the number of heterosexual couples living with HIV increases. Unfortunately there are other rumors spread by the elders in Cameroon. "These parents speculate that HIV/AIDS is a sexually transmitted disease that is passed on from Fulani women only to non-Fulani men who have sexual contact with them and also claims that a man is infected as a result of sexual contact with a woman Fulani , only a healer Fulani who can treat it ". This communal belief is shared by many other African cultures who believe that HIV and AIDS are from women. Because of this belief that men can only get HIV from women many "women are not free to talk about their HIV status to their partners for fear of violence". In general HIV carries a negative stigma in Sub-Saharan Africa. Unfortunately this stigma makes it very difficult for Sub-Saharan Africans to share that they have HIV because they are afraid of being ostracized from their friends and family. In every Sub-Saharan community, HIV is seen as the bearer of death. The common belief is that once you are infected with HIV, you are destined to die. People alienated themselves based on this belief. They do not tell their families and live with guilt and fear because of HIV. However, there are ways to treat HIV and AIDS, the problem is that many are not aware of how HIV spreads or what impact it has on the body. "80.8% of participants will not sleep in the same room as HIV-positive people, while 94.5% will not talk to someone who is HIV positive".

Social stigma plays an important role in HIV infection and AIDS in Africa. "In the Sub-African HIV community that is normative HIV/AIDS-stigma, suspicion of someone's status by others also applies to non-HIV positive individuals, but who may wish to take advantage of health care services for prevention purposes These individual groups under fear of suspicion can avoid being misidentified as stigmatization by simply avoiding the use of HARHS. "(151)

"At the individual level, people living with HIV/AIDS in Sub-Saharan Africa may wish to conceal their stigmatization identity whenever possible to obtain this award in relation to having a 'normal' identity.The rewards are considered normal 'in the context of Sub-Saharan HIV prevalence Africa varies and is remarkable... such an appreciation in which there is empirical support in this context including perceived sexual freedom, avoidance of discrimination, avoidance of community or family rejection, avoidance of loss of work or shelter, and avoidance of loss of a sexual partner. others that are considered normal include avoiding dealing with promiscuity or prostitution, avoiding emotional, social and physical isolation and avoiding blame for the illness of others "(150).

Combination prevention program

The UN Joint Program on HIV/AIDS defines a combination prevention program as:

rights-based, evidence-based, and community-owned programs that use a mix of biomedical, behavioral, and structural interventions, are prioritized to meet current HIV prevention needs of specific individuals and communities, thus having the greatest sustained impact on reducing new infections. Well designed programs... carefully tailored to national and local needs and conditions; focus resources on the mix of program actions and policies needed to address the underlying direct risks and vulnerabilities; and... are carefully planned and managed synergistically and consistently at various levels (eg individuals, relationships, communities, communities) and over an adequate period of time.... Using different preventive strategies in combination is not a new idea.... [C] ombinasi approach has been used effectively to produce a sharp sustained reduction in new HIV infections in various settings. Combination prevention reflects common sense, but it is very surprising how rarely does such an approach apply.... Prevention efforts to date have been heavily focused on reducing individual risks, with less effort being made to address social factors that increase HIV vulnerability.... The UNAIDS combination prevention framework places structural interventions - including programs to promote human rights, to remove punishment laws that impede the AIDS response, and to combat gender inequalities and HIV-related stigma and discrimination - at HIV prevention centers. Schedule of events.

"This is a consensus in the HIV scientific community that abstinence, faithfulness, using condom principles [(ABC)] is an important guide to public health intervention, but better bundled with a biomedical prevention approach, the only behavioral change approach is unlikely to stop global pandemics. "Uganda has replaced ABC's strategy with a combination prevention program due to an increase in the rate of HIV infection per year. Most new infections come from people in long-term relationships that have multiple sexual partners.

Abstinence, faithfully use condom

Abstinent, faithful, using condom strategies (ABCs) to prevent HIV infection promotes safer sexual behavior and emphasizes the need for loyalty, fewer sexual partners, and a younger age of sexual debut. ABC implementation is different among those who use it. For example, the President's Emergency Plan for AIDS Prevention has been more focused on abstinence and loyalty than condoms while Uganda has a more balanced approach to the three elements.

The effectiveness of ABC is controversial. At the 16th International AIDS Conference in 2006, African countries provided a mixed review strategy. In Botswana,

[M] uch from the ABC message is over, but... it does not make much difference.... A program called Total Mobilization Society sends 450 home-based AIDS counselors, provides preventive advice, encourages HIV testing and refers to infected people to treatment.... People who have talked to counselors are twice as likely to say they are not abstinent and three times more likely to mention condom use when asked to explain ways to avoid infection. However, they are no more likely than the unreasonable to mention that they are faithful as a good strategy. People who had been counseled were also twice as likely to be tested for HIV the previous year, and had discussed the possibility with a sex partner. However, they tend to have non-marital partners as people who do not get visits from counselors, and they are no more likely to use condoms in the relationship.

Di Nigeria,

There are somewhat different results in a study of Nigerian youth, ages 15 to 24, mostly unmarried, living in the city and working in crowded jobs. People in certain neighborhoods are counseled with ABC messages as part of a seven-year project funded by the US Agency for International Development and its British counterpart.... Groups that do not reflect show no increase in condom use - it stays about 55 percent. However, in the counseling group, condom use by women in their last non-marital sexual relationship increased from 54 percent to 69 percent. For men, up from 64 percent to 75 percent. Stigmatization seems less common among counseling groups.... But... "We do not see a reduction in the number of partners," said Godpower Omoregie, a researcher from Abuja who presented the findings.

In Kenya,

A survey of 1,400 Kenyan adolescents found some confusion about ABC messages.... Half of teenagers can properly define abstinence and explain why it matters. Only 23 percent can explain what loyalty means and why it matters. Some people think it means being honest, and some people think it means having confidence in their partner's loyalty. Only 13 percent can correctly explain the importance of condoms in preventing HIV infection. About half spontaneously offer negative opinions about condoms, saying they are unreliable, immoral and, in some cases, designed to allow HIV to be transmitted.

Swaziland in 2010 announced that they abandoned ABC's strategy because it was a miserable failure to prevent the spread of HIV. "If you see an increase in HIV in this country while we've been implementing the ABC concept for so long, then it's clear that ABC is not the answer," said Dr. Derek von Wissell, Director of the National Emergency Response Council on HIV/AIDS.

Fighting HIV exhaustion

One of the biggest problems facing African countries with high prevalence rates is "HIV fatigue". Africans are not interested in hearing more about the disease they have heard constantly. To overcome this, a new approach is needed.

In 1999, the Henry J. Kaiser Family Foundation and the Bill and Melinda Gates Foundation provided substantial funds for loveLife websites, sexual health and sexual relationships for teenagers.

In 2011, Botswana Ministry of Education introduced new HIV/AIDS education technologies in local schools. TeachAIDS prevention software, developed at Stanford University, is distributed to every elementary, middle, and tertiary educational institution in the country, reaching all students from ages 6 to 24 across the country.

African Union effort

AIDS Watch Africa

During the Abuja African Union Summit on HIV/AIDS in April 2001, the heads of state and government of Botswana, Ethiopia, Kenya, Mali, Nigeria, Rwanda, South Africa and Uganda established the AIDS Watch advocacy platform (AWA). The initiative was set up to "accelerate efforts by Heads of State and Government to implement their commitments to combat HIV/AIDS, and to mobilize necessary national and international resources." In January 2012, AWA was revitalized to cover the whole of Africa and its goal was expanded to include malaria and tuberculosis.

Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa

In 2012, the African Union adopted the Road Map of Joint Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa. This Road Map presents a set of solutions sourced from Africa to increase the shared responsibility and global solidarity for AIDS prevention... in Africa on a sustainable basis by 2015. The solution is structured around three strategic pillars: diverse financing; access to drugs; and improved health governance. The Roadmap defines the objectives, results, roles, and responsibilities to keep the stakeholders accountable for the realization of this solution between 2012 and 2015.

Prevent HIV transmission from pregnant women to children

The United Nations Program on HIV/AIDS reports that the following sixteen African countries by 2012 "confirm [d] that more than three quarters of pregnant women living with HIV receive antiretroviral drugs to prevent transmission to their children": Botswana, Gabon, Gambia, Ghana, Mauritius, Mozambique, Namibia, Rwanda, SÃÆ' £ o Tomà © Ã… © and Principe, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe.

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Cause and spread

Behavioral factors

High risk behavior patterns have been cited as being the most responsible for the spread of HIV/AIDS significantly greater in Sub-Saharan Africa than in other parts of the world. The chief among these is the traditional liberal stance embraced by the many communities that inhabit the continent toward multiple sexual partners and pre-marital and extramarital sexual activity. Transmission of HIV is most likely to occur in the first few weeks after infection, and therefore increases when people have more than one sexual partner in the same time period. In most developed countries outside Africa, this means high HIV transmission among prostitutes and others who may have more than one sexual partner simultaneously. In sub-Saharan African cultures, it is relatively common for men and women to have sexual intercourse with more than one person, which promotes HIV transmission. This practice is known as concurrency, which Helen Epstein describes in her book The Invisible Cure: Africa, the West, and the Fight against AIDS, where her research into Ugandan sexual mores reveals the high frequency at which men and women engage in concurrent sexual intercourse. In addition, in sub-Saharan Africa AIDS is a major killer and the big reason for high rates of transmission is due to a lack of education provided to young people. When infected, most children die within a year due to lack of care. All inhabitants in Sub-Saharan Africa are infected with HIV, from male to female, and from pregnant women to children. Rather than having more infected groups, male or female, the ratio of HIV-infected men and women is very similar. With HIV infection, 77% of men, women, and children, developed AIDS, and died in Sub-Saharan Africa. Of the deaths, "more than 90% of orphans and AIDS children [were] infected with HIV.

Lack of money is a clear challenge, although much aid is distributed throughout developing countries with high levels of HIV/AIDS. For African countries with advanced medical facilities, patents on many drugs have hindered the ability to make low cost alternatives.

Natural disasters and conflicts are also a major challenge, since the economic problems facing people can encourage many young women and girls into sex work patterns to ensure their livelihoods or their families, or to secure roads, food, shelter. or other resources. Emergencies can also lead to greater exposure to HIV infection through new sex work patterns. In Mozambique, the inclusion of humanitarian workers and transporters, such as truck drivers, attracts sex workers from outside the region. Similarly, in the Turkana District of northern Kenya, drought causes a decrease in clients for local sex workers, encouraging sex workers to loosen their condom use demands and locate new truckers clients on major highways and in suburban settlements.

Health industry

Sub-Saharan "Africans always appreciate the importance of health care because good health is deemed necessary for the continuation and growth of their lineage". Without good health, culture can not develop and develop. Unfortunately, "health services in many countries are flooded with the need to care for the increasing number of infected and sick people, ameliorative drugs are too expensive for the vast majority of victims, except for a very small number of prosperous". The largest number of sick with the fewest number of doctors, Sub-Saharan Africa "has 11 percent of the world's population but carries 24 percent of the global disease burden, with less than 1 percent of global health spending and just 3 percent of the world's health workers."

When family members are ill with HIV or other illness, family members often end up selling most of their items to provide health care for the individual. Medical facilities in many African countries are lacking. Many health care workers are also unavailable, partly due to lack of training by the government and partly because it is pushed by these workers by foreign medical organizations where there is a need for medical professionals. Unfortunately, many individuals who get medical degrees eventually leave Sub-Saharan Africa to work abroad "to avoid instability or to practice where they have better working conditions and higher salaries". Many low-income people are very far from the hospital and they can not afford to go there or pay medical attention once they arrive. "Health care in Africa is very different, depending on the country as well as the region - those living in urban areas are more likely to receive better health services than in rural or remote areas". It is common to wait for illness or seek help from neighbors or relatives. Currently antiretroviral therapy is the closest to the drug. However, many hospitals lack antiretroviral drugs to treat everyone. This may be because most Sub-Saharan African countries are investing "at least $ 1-4 per capita, [so] foreign aid is a major source of funding for health care." Many overseas organizations are very hesitant to provide antiretroviral drugs to Sub-Saharan Africa because they are expensive, which means there is only so much they can provide. Relying on other countries for help generally requires more documents and confidence in other countries that are very far away. Also, drug delivery and other assistance take months and years to reach the hands of those in need.

Medical factors

Circumcision

According to a 2007 report, male and female circumcision was statistically associated with an increased incidence of HIV infection among women in Kenya and men in Kenya, Lesotho and Tanzania who reported on their own that they were both undergoing procedures and virgins. "Among adolescents, regardless of sexual experience, circumcision is as strong as a common HIV infection." Circumcised adults, however, are statistically less likely to be HIV positive than uncircumcised counterparts, especially among older age groups.

Similarly, trials of randomized, controlled interventions in South Africa from 2005 found that male circumcision "provides a level of protection against transmission of HIV infection [by men], equivalent to what high-efficacy vaccines will be achieved".

Medical suspicion

There is a high level of medical suspicion throughout Africa, and there is evidence that such distrust can have a significant impact on the use of medical services. The distrust of modern medicine is sometimes associated with the theory of "Western Plot" mass sterilization or population reduction, perhaps a consequence of some high-profile incidents involving western medical practitioners.

Pharmaceutical industry

African countries are also still struggling against what they consider to be unfair practices in the international pharmaceutical industry. Medical trials occur in Africa on many drugs, but once approved, access to drugs is difficult. Pharmaceutical companies should return the money they invest for research and work to obtain patents on their intellectual capital investments that limit generic alternative production. Patents on drugs have prevented access to drugs as well as growth in research for more affordable alternatives. These drugs insist that drugs should be purchased through them.

South African scientists in a joint effort with American scientists from Gilead Sciences recently tested and found an effective tenofivir-based vaginal anti-retroviral gel that could be used as a pre-exposure prophylaxis. The gel test was conducted at the University of KwaZulu-Natal in Durban, South Africa. The South African government has indicated its willingness to make it widely available. The FDA in the US is in the process of reviewing the drug for approval for US use. The AIDS/HIV outbreak has led to an increase of unethical medical experiments in Africa.

Since the epidemic has widespread, African governments sometimes loosen their laws to get research done in their countries that they can not afford. However, global organizations such as the Clinton Foundation, working to reduce the cost of HIV/AIDS drugs in Africa and elsewhere. For example, philanthropist Inder Singh oversees programs that reduce the cost of pediatric HIV/AIDS drugs between 80 and 92 percent by working with producers to reduce production and distribution costs. Manufacturers often cite the difficulties of distribution and production in emerging markets, which creates a substantial barrier to entry.

Political factors

African political leaders have rejected links between HIV and AIDS, supporting alternative theories. The scientific community considers evidence that HIV causes AIDS to be conclusive and rejects AIDS-denialist claims as pseudoscience based on conspiracy theories, false reasoning, cherry selection, and misinterpretations of largely outdated scientific data. Despite the lack of scientific acceptance, AIDS denialism has a significant political impact, especially in South Africa under former president Thabo Mbeki.

Subtype factor

In Africa, subtype C of HIV-1 is very common, while rare in the United States or Europe. People with subtype C progress to AIDS faster than those with subtype A, the dominant subtype in America and Europe (see HIV disease progression rate # variation of HIV subtype and effect on developmental level).

Religious factors

The pressure from some religious leaders has resulted in the prohibition of a number of safe sex campaigns, including condoms promoting banned ads in Kenya.

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Health Care

Many people living with HIV in low- and middle-income countries who require antiretroviral therapy can not access or remain in care. This is often due to the time and expense required to travel to health centers as well as the number of inadequately trained staff such as doctors and specialists to provide care. One approach to improving access to HIV care is to provide antiretroviral therapy close to people's homes. A systematic review found that when antiretroviral treatment was initiated in the hospital but followed up at health centers closer to home, fewer patients died or were lost to follow-up. The study also did not detect differences in the number of patients who died or were lost to follow-up when they received treatment care in the community rather than in a health center or hospital.

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Measurement

Prevalence includes all people living with HIV and AIDS, and presents a delayed epidemic representation by combining HIV infection for many years. Incidence, by contrast, measures the number of new infections, usually more than the previous year. There is no practical and reliable way to assess incidents in Sub-Saharan Africa. Prevalence in pregnant women ages 15 to 24 who come to antenatal clinics is sometimes used as an approach. The test done to measure prevalence is serosurvei in which blood is tested for the presence of HIV.

The health unit that performs serosurveys rarely operates in remote rural communities, and the data collected also does not measure people seeking alternative health care. The extrapolation of national data from an antenatal survey depends on assumptions that may not apply in all regions and at different stages in the epidemic.

A recent national population survey or household-based survey that collects data from both sexes, pregnant and nonpregnant women, and rural and urban areas, has adjusted the national prevalence rates recorded for several countries in Africa and elsewhere. This is also not perfect: people may not participate in household surveys because they fear they may be HIV positive and do not want to know their test results. Household surveys also exclude migrant workers, who are high-risk groups.

Thus, there may be a significant difference between official numbers and actual HIV prevalence in some countries.

A small proportion of scientists claim that as many as 40 percent of HIV infections in adults in Africa may be caused by unsafe medical practices and not by sexual activity. The World Health Organization states that about 2.5 percent of HIV infections in Sub-Saharan Africa are caused by unsafe medical injection practices and "the vast majority" by unprotected sex.

src: www.sciencemag.org

Regional prevalence

Unlike the areas of North Africa and the Horn of Africa, traditional cultures and religions in most Sub-Saharan Africa generally exhibit a more liberal attitude toward the sexual activity of women outside of marriage. The latter include practices such as multiple sexual partners and unprotected sex, high-risk cultural patterns that have been implicated in the far greater spread of HIV in the subcontinent.

North Africa

Uniquely among the countries in the region, the HIV prevalence rate in Morocco has increased from less than 0.1 percent in 2001 to 0.2 percent in 2011.

Horn of Africa

As in North Africa, HIV infection rates in the Horn of Africa are generally quite low. This has been attributed to the Muslim nature of many local communities and adherence to Islamic morals.

The HIV prevalence rate in Ethiopia has dropped from 3.6 percent in 2001 to 1.4 percent in 2011. The number of new infections per year has also decreased from 130,000 in 2001 to 24,000 in 2011.

Central Africa

The rate of HIV infection in Central Africa is generally moderate to high.

East Africa

The rate of HIV infection in East Africa is generally moderate to high.

Kenya

Kenya, according to a 2008 report from the UN Joint Program on HIV/AIDS, has the third largest number of individuals in Sub-Saharan Africa living with HIV. It also has the highest prevalence rates in any country outside of South Africa. The rate of HIV infection in Kenya fell from about 14 percent in the mid-1990s to 5 percent in 2006, but rose again to 6.2 percent in 2011. The number of newly infected individuals per year, however, decreased by almost 30 percent, from 140,000 in 2001 to 100,000 in 2011.

In 2012, Nyanza Province had the highest HIV prevalence rate at 13.9 percent, with the North Eastern Province having the lowest rate at 0.9 percent.

Christian men and women also have higher rates of infection than their Muslim counterparts. This distinction is particularly marked among women, with Muslim women showing a rate of 2.8 percent versus 8.4 percent among Protestant women and 8 percent among Catholic women. HIV is also more common among the richest than among the poorest (7.2 percent versus 4.6 percent).

Historically, HIV is more prevalent in urban than in rural areas, although the gap is very rapid. Men in rural areas are now more likely to be infected with HIV (at 4.5 percent) than those in urban areas (at 3.7 percent).

Tanzania

Between 2004 and 2008, HIV incidence rates in Tanzania for ages 15-44 slowed to 3.37 per 1000 person-years (4.42 for women and 2.36 for men). The number of newly infected individuals per year slightly increased, from 140,000 in 2001 to 150,000 in 2011. There were also significantly fewer HIV infections in Zanzibar, which in 2011 had a prevalence rate of 1.0 percent compared with 5.3 percent in mainland Tanzania.

Uganda

Uganda has recorded a gradual decline in its HIV level from 10.6 percent in 1997, to a steady 6.5-7.2 percent since 2001. This has been linked to changes in local behavior patterns, with more respondents reporting the use of contraceptives greater and a two-year delay in first sexual activity and fewer people reporting casual sexual relationships and multiple partners.

The number of newly infected individuals per year, however, has risen by more than 50 percent, from 99,000 in 2001 to 150,000 in 2011. More than 40 percent of new infections among married couples, showing widespread and increasing affluence. This increase has caused an alarm. Director of the Centers for Disease Control - Uganda, Wuhib Tadesse, said in 2011 that,

for every person starting antiretroviral therapy, there are three new HIV infections [,] and this is not sustainable. We are... very concerned.... [C] omplacence could be part of the problem. Young people now no longer see people dying; they see people using ARVs but getting kids. We need to reexamine our strategy.... Leaders at all levels spend... [more] time in the workshop than in the community to be sensitive to people [,] and this must be stopped. "

West Africa

West Africa generally has moderate infection rates for HIV-1 and HIV-2. The onset of the HIV epidemic in the region began in 1985 with cases reported in Benin, Mali and Nigeria. This was followed in 1986 by Burkina Faso, CÃÆ'Â'te d'Ivoire, Ghana, Liberia, and Senegal. The epidemic began in Niger, Sierra Leone, and Togo in 1987; in Gambia, Guinea, and Guinea-Bissau in 1989; and in Cape Verde in 1990.

HIV prevalence in West Africa is lowest in Senegal and the highest in Nigeria, which has the second largest number of people living with HIV in Africa after South Africa. The rate of Nigerian infections (the number of patients relative to the entire population), however, was much lower (3.7 percent) compared with South Africa (17.3 percent).

The main driver of infection in the region is commercial sex. In the Ghana capital of Accra, for example, 80 percent of HIV infections in young men are obtained from women who sell sex. In Niger in 2011, the national HIV prevalence rate for ages 15-49 was 0.8 percent while for sex workers 36 percent.

South Africa

In the mid-1980s, HIV and AIDS was almost unheard of in southern Africa. However, it is now the most affected area in the world. Currently, Swaziland and Lesotho have the highest and second highest prevalence rates of HIV in the world. Of the nine southern African countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe), four are estimated to have an infection rate of more than 15 percent.

In Botswana, the number of newly infected individuals per year has decreased by 67 percent, from 27,000 in 2001 to 9,000 in 2011. In Malawi, the decline was 54 percent, from 100,000 in 2001 to 46,000 in 2011. All but two of Other countries in the region also recorded large declines (Namibia, 62 percent, Zambia, 54 percent, Zimbabwe, 47 percent, South Africa, 38 percent, Swaziland, 32 percent). The numbers remain almost the same in Lesotho and Mozambique.

The first HIV case Zimbabwe reported was in 1985.

In addition to polygynous relationships, which can be very common in some parts of Africa, there is also widespread sexual networking practices that involve multiple overlapping or simultaneous sexual partners. Male sexual networks, in particular, tend to be quite broad, a fact that is received secretly or even encouraged by many communities. Together with having multiple sexual partners, unemployment and population movements due to drought and conflict have contributed to the spread of HIV/AIDS. According to Susser and Stein (2000), men refuse to use condoms during sex with women or women who engage in sex work. (pp. 1043-1044). Unfortunately, girls and women desperately need money and have no choice. This leads to many sex partners, which increases the likelihood of their infection with HIV/AIDS.

A 2008 study in Botswana, Namibia, and Swaziland found that intimate partner violence, extreme poverty, education, and earnings inequalities explain almost all differences in HIV status among adults aged 15-29. Among young women with one of these factors, the HIV rate increased from 7.7 percent with no factor to 17.1 percent. About 26 percent of young women with two factors were HIV positive, with 36 percent of those with three factors and 39.3 percent of those with all four factors becoming HIV-positive.

Most of the HIV infections found in southern Africa are HIV-1, the most common HIV infection in the world. It dominates everywhere except west Africa, where HIV-2 is more frequent.

Swaziland

In 2011, the HIV prevalence rate in Swaziland was the highest in the world at 26.0 percent of people aged 15-49. The United Nations Development Program wrote in 2005,

Large scale AIDS-related diseases and deaths weaken the capacity of governments for service delivery, with serious consequences on food security, economic growth [and] human development. AIDS undermines the capacity of individuals, families, communities, and countries to fulfill their roles and responsibilities in society. If the current trend does not reverse, the long-term viability of Swaziland as a country will be seriously threatened.

The HIV outbreak in Swaziland has reduced life expectancy at birth to 49 for men and 51 for women (based on 2009 data). Life expectancy at birth in 1990 was 59 for men and 62 for women.

Based on data for 2011, Swaziland's gross mortality rate of 19.51 per 1,000 people per year is the third highest in the world, behind only Lesotho and Sierra Leone. HIV/AIDS in 2002 caused 64 percent of all deaths in the country.

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Coinfected tuberculosis

Many epidemic deaths in Sub-Saharan Africa are caused by a deadly synergy between HIV and tuberculosis, the so-called "co-epidemic". Both diseases have been "inseparably bound" since the beginning of the HIV epidemic. "Tuberculosis and HIV co-infection are associated with special diagnostic and therapeutic challenges and are a huge burden on heavily infected country health care systems such as Ethiopia." In many countries without adequate resources, the rate of tuberculosis cases has increased five to tenfold since HIV identification. Without proper treatment, an estimated 90 percent of people living with HIV die within a few months after contracting tuberculosis. The initiation of highly active antiretroviral therapy in people coinfected with tuberculosis may lead to recombination immune reconstitution syndrome with worsening, in some severe cases worsening, tuberculosis and symptomatic infections.

An estimated 874,000 people in Sub-Saharan Africa live with HIV and tuberculosis in 2011, with 330,000 in South Africa, 83,000 in Mozambique, 50,000 in Nigeria, 47,000 in Kenya, and 46,000 in Zimbabwe. In terms of cases per 100,000 population, the Swaziland 1,010 rate was the highest in 2011. In the following 20 African countries, the rate of case coinfection per 100,000 increased by at least 20 percent between 2000 and 2011: Algeria, Angola, Chad, Comoros, Republic of Congo, Democratic Republic of Congo, Equatorial Guinea, Gambia, Lesotho, Liberia, Mauritania, Mauritius, Morocco, Mozambique, Senegal, Sierra Leone, South Africa, Swaziland, Togo and Tunisia.

Since 2004, however, tuberculosis-related deaths among people living with HIV have dropped by 28 percent in Sub-Saharan Africa, which is home to nearly 80 percent of people worldwide living with both diseases.

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See also

• 28: Acts of AIDS in Africa
• African Demography
• Global Fund to Fight AIDS, Tuberculosis and Malaria
• HIV/AIDS in Malawi
• HIV/AIDS in Asia
• HIV/AIDS in Australia
• HIV/AIDS in Europe
• HIV/AIDS in North America
• HIV/AIDS in South America
• The Origin of AIDS
• Presidential Emergency Plan for AIDS Relief
• South African pandemic model
• UN Special Envoy for HIV/AIDS in Africa
• The Rachel Student Initiative, an educational project that works for disadvantaged young people like orphaned AIDS along with the OVC project for the Adigrat and Tigray region of Ethiopia

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Note

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References

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Further reading

• AIDS Encyclopedia: Social, Political, Cultural and Scientific Notes from the HIV Epidemic , Raymond A. Smith (ed), Penguin Books. ISBN: 0-14-051486-4.
• John Iliffe, "The African AIDS Epidemic: A History," Jamedn s Currey, 2006, ISBNÃ, 0-85255-890-2
• Pieter Fourie, "Political HIV and AIDS Management in South Africa: One burden too much?" Palgrave Macmillan, 2006, ISBNÃ, 0-230-00667-1

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External links

• AIDS Changing Demography of Reverse Africa , Allianz's Knowledge, October 18, 2007
• AIDS: Voices From Africa - slideshow by Life magazine
• Aids Clock (UNFPA)

Source of the article : Wikipedia